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Expert Business and Law Advice Amanda C. Fields, General Counsel to American Pharmacies
Roger Buchhorn, CPA APRx Audit Exit Interview Form Use TDI as Your Dispute Adjudicator The Texas Department of Insurance continues to work closely with the Texas
Department of Insurance (TDI) to help the independent pharmacy profession submit
and resolve complaints against health maintenance organizations, insurers and the
entities they contract with to process and pay claims-pharmacy benefit managers
(PBMs). TPBC's staff and consultants have participated in a continuing series of
pharmacy outreach efforts with TDI since 2009, with the overall goal to enhance the
complaint resolution process for you. Complaints made against you to the Texas State Board of Pharmacy Anyone may file a complaint with the Texas State Board of Pharmacy against a pharmacy or pharmacist, but complaints must be received in writing. Each complaint is thoroughly evaluated, first to determine if the complaint (allegations) involves a person or a pharmacy licensed by this Board, and secondly, whether the allegations, if true, would be a violation of the Texas Pharmacy Act or Texas Drug Laws. If the complaint is not under the jurisdiction of TSBP, it may close the complaint with no action or refer the complaint to another agency or entity. TSBP does not have jurisdiction over complaints involving rudeness, customer service, and/or pricing/billing disputes. If the complaint is within the jurisdiction of TSBP, the complaint may be referred to an investigator. An investigator may contact the complainant for additional information about the complaint. The investigator may also contact you, the licensee, for additional information about the complaint and/or your response to the substance of the complaint. The Independent Pharmacist's Duty to Warn As American Pharmacies' members well know, the pharmacy profession continues to evolve from that of dispensing pharmaceutical products to dependable health care providers who are an integral part of the health care circle and frequently provide patient counseling services and sound medical advice. As the pharmacist's role has expanded, so has his/her accountability, particularly in regard to the dialogue centering on the pharmacist's duty to warn. Under the DTW theory of liability in medical malpractice lawsuits, patients injured by prescription drugs claim that the pharmacist has a DTW about the potential adverse effects and dangers associated with the drugs. Auditing Loopholes in Medicare Part D Introduction Firing Tips For The Independent Pharmacist Introduction Hiring Tips For The Independent Pharmacist Introduction The Pharmacist's Guide to the On-Site Audit Process Introduction More often than not, on-site audit notifications request review of records and/or documents that are not within the time or relevance scope of permissibility under Texas law. Unfortunately, many of the pharmacies that receive these notifications simply comply because of a lack of understanding about Texas law, as well as a fear of the perceived consequences for noncompliance. Once the insurance company or PBM has conducted an on-site audit, they characteristically send correspondence notifying the pharmacy that they will be recouping money by taking out payments from future money due. Many of the pharmacies are giving up their reimbursement in order to continue the "dubious privilege" of doing business with their current tormentor. It is imperative that pharmacies take steps to prevent audits, be conscious of their rights under Texas law, voice their opposition to unlawful on site audits and appeal any demands for recoupment. This guide will briefly shed light on how to handle the on-site audit. Download the PDF file to read the rest of the article and find out how to prevent an on-site audit... Contracting TIPS for the Independent Pharmacist (PDF download) Don’t rely on an oral agreement. Reduce the agreement to writing with a written contract. Although oral agreements are often legally binding, they are difficult to prove and enforce in court. A written contract is less uncertain than an oral agreement because you have a document that clearly delineates each party's obligations and rights. Do insist that the details are correct. Do include the date in the first paragraph so that the contract is easily referenced after execution, such as "the December 1, 2007 contract for consulting services." Do ensure that the parties are properly identified, names are spelled correctly and addresses are accurate. Be certain that the appropriate legal name of the party to the contract is named, so that it is obvious who is responsible for performing the obligations. For example, if your pharmacy is organized as a corporation or limited liability company, then identify it accordingly (including “Inc.” or “L.L.C.” and the d/b/a name), not by the name of the person signing the agreement on behalf of the pharmacy. Safeguarding Your Business from Employee Fraud (PDF download) Employee fraud is one of the most common crimes committed against businesses today. Yet surprisingly, many owners take few precautions because they do not believe it is an issue in their organization. Unfortunately, avoiding the situation is the single most contributing factor that allows, and even encourages, employee theft. An owner must understand and accept the possibility of fraud within the business in order to prevent it.
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